review article - hindawiisrn nursing 3 schools of nursing. the reviewed studies are summarized in...

International Scholarly Research NetworkISRN NursingVolume 2012, Article ID 806543, 9 pagesdoi:10.5402/2012/806543

Review Article

Perceived Barriers to Success for Minority Nursing Students:An Integrative Review

Collette Loftin,1 Susan D. Newman,2 Bonnie P. Dumas,2 Gail Gilden,2 and Mary Lou Bond3

1 Department of Nursing, West Texas A&M University, Canyon, TX 79016, USA2 College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA3 College of Nursing, University of Texas, Arlington, TX 76019, USA

Correspondence should be addressed to Collette Loftin, [email protected]

Received 7 March 2012; Accepted 1 April 2012

Academic Editors: S. Keeney and B. Roberts

Copyright © 2012 Collette Loftin et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The objective of this paper was to identify barriers to successful program completion faced by underrepresented minority nursingstudents. This paper reveals that minority nursing student’s face multiple barriers to success including lack of financial support,inadequate emotional and moral support, as well as insufficient academic advising, program mentoring, technical support, andprofessional socialization. An additional theme—a resolve to succeed in spite of the identified barriers—was identified. This bodyof literature focuses solely on successful minority students’ experiences, revealing a significant gap in the research. The findings ofthis paper highlight the need to create and maintain nursing programs capable of aggressively supporting minority student needs.Recommendations for future research are included.

1. Introduction

The increasing diversity of the United States is evidenced bya recent census report predicting that by midcentury, racialand ethnic minorities will make up over half of the UnitedStates’ population [1]. A culturally diverse nursing workforceis critically needed to meet the healthcare needs of thisincreasingly diverse population. Recruiting and retainingunderrepresented minority (URM) nursing students con-tinues to be an important component of this process butremains a challenge for the nursing education community.National nursing and healthcare organizations including theNational League for Nursing (NLN), the American Associa-tion of Colleges of Nursing (AACN), the Institute of Medi-cine (IOM), and the American Nurses Association (ANA)agree that increasing the racial and ethnic diversity of stu-dents in US nursing programs is a high priority [2–5]. Byincreasing recruitment and improving retention and gradu-ation rates of minority nursing students, nursing programscould facilitate increased minority representation in the nur-sing workforce.

2. Background and Significance

Registered nurses represent the largest number of profes-sional healthcare workers in the United States. However, theracial and ethnic background of the nursing workforce is notreflective of the general population as a whole. Like otherhealthcare professions, minority representation in nursing islagging [4]. Initial findings from the 2008 Sample Survey ofRegistered Nurses report that although the minority pop-ulation constitutes 37 percent of the country’s population,minority nurses make up only 16.8 percent of the total nursepopulation [6]. In addition to being the largest group ofhealthcare providers, nurses work in virtually all healthcareand community settings. Consequently, changes in the ethnicand racial composition of the nursing workforce have thepotential to influence healthcare across all areas and settings.

Perhaps the most compelling reason for increasing thenumbers of underrepresented minority nurses is the lackof equity in regard to healthcare access and quality. Thegroundbreaking Institute of Medicine (IOM) report UnequalTreatment documented disparities found in the access toand quality of the healthcare provided to racial and ethnic

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minorities [7]. Race and ethnicity play significant roles inthe care minority patients receive even when other factorsare considered equal such as health insurance coverage andincome [7]. Studies show that minority Americans are muchmore likely to die in infancy, suffer higher rates of chronicdiseases, and have shorter life spans than majority Ameri-cans [8]. According to the Sullivan Commission [9], “Therationale for increasing diversity in the health workforce isevident: increased diversity will improve the overall health ofthe nation” (page 3).

Efforts to increase diversity in nursing programs haveresulted in increased admission of minority students. Ac-cording to the AACN [10], the percentage of students fromURM backgrounds in prelicensure baccalaureate programsduring 2010 was at its highest rate ever—26.6%. Historicallyhowever, high attrition rates have been a significant concern[11–13]. There is a dearth of research exploring the asso-ciation between attrition and diversity [14, 15]. While thereremains a lack of consistent documentation regarding attri-tion rates, estimates for minority nursing students haveranged from 15–85 percent [11, 13, 16].

The Health Resources and Services Administration(HRSA) Nursing Workforce Diversity program has awardedmillions in funding for projects to increase nursing educationopportunities for students from racial and ethnic minoritiesunderrepresented among registered nurses [17]. The fundingprovides student stipends, enrichment and recruitment pro-grams, and retention activities. In 2009, 51 workforce diver-sity grants were funded providing $16 million in aid [5].

3. Purpose

There has been continued demand for increased diversity innursing thus a review of current literature regarding thebarriers to successful program completion is warranted. Im-proved awareness about the barriers will enable educators todirect future efforts toward interventions that effectivelyimpact and facilitate successful program completion for un-derrepresented minority nursing students. The purpose ofthis paper is to integrate the findings from recent studiesidentifying perceived barriers to nursing program comple-tion for URM nursing students.

4. Methodology

This integrative review follows the five stages of review asproposed by Whittemore and Knafl [18]. These stages in-clude problem identification, literature search, data evalua-tion, data analysis, and presentation. There has been muchpublished in nursing journals offering expert opinion andsuggestions to increase diversity in nursing education and inthe nursing workforce. This paper is limited, however, to thepublished research reporting barriers to successful programcompletion for URM students in prelicensure nursing pro-grams.

A comprehensive search of the literature was performedto locate such articles published between 1996 and 2011. Thissearch was completed in early spring of 2011. The following

online databases were utilized in this search: CumulativeIndex of Nursing and Allied Health Literature (CINAHL),Educational Resources Information Center (ERIC), EBSCO,and Pub Med. The following search terms were used aloneand in combination: nursing workforce, diversity, nursingstudent, ethnicity, minority, nursing education, barriers, andunderrepresented minority. Once a study was identified, theauthor(s) were added as additional search terms. Additionalarticles were identified through a hand search of referencelists. This search strategy yielded 613 articles.

Titles and abstracts were reviewed in depth to determinestudies’ relevance for inclusion in this paper based on thefollowing criteria. Exclusion criteria included studies pub-lished prior to 1996, studies conducted outside the U.S., orarticles that were not published in English. Studies that werelimited to minority student experiences in graduate nursingprograms were not included. Commentaries, expert opinionpieces, and review articles were also excluded. Seventeenpublications met the selection criteria and were includedin this review. Once identified, results of the studies werecarefully reviewed and analyzed. Analysis was aided by pre-sentation in a table format under the headings of author/date, study purpose, study design, sample, and findings.

5. Conceptual Framework

The Adapted Model of Institutional Support conceptuallyinformed this review. The Model of Institutional Support[19] was originally developed to describe institutional sup-ports necessary to assist Hispanic doctoral students. Valverdeand Rodriquez based this model on a review of the literatureand a retrospective examination of their own experiencesas doctoral students. The constructs of their original modelincluded financial support and opportunity, moral and emo-tional support, faculty and professional mentorship, andtechnical support.

Valverde and Rodriguez introduced the significance ofacademic advising in their initial mentorship construct.Bond et al. adapted the model by extracting academic advis-ing into a fifth construct [20]. They further revised the modelto include a sixth construct. Professional socialization wasoriginally identified by Conway as vital for graduate students[21]. The construct was considered similarly important forundergraduates by Bond and colleagues and subsequentlyadded as the sixth construct.

6. Results

A majority of the reviewed studies (16 of 17) utilized aqualitative methodology employing, open-ended interview,focus groups, or questionnaires that included open-endeditems to explore and describe the students’ experiences ina prelicensure nursing program. Both associate degree andbaccalaureate degree student perspectives were included inthe reviewed studies. Similarity was noted in the studies’stated purpose which often sought to identify personal and/or educational barriers encountered by the students as wellas explication of their experiences in predominately White

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schools of nursing. The reviewed studies are summarizedin Table 1. The barriers identified in this paper are organi-zed by the concepts of the Adapted Model of InstitutionalSupport.

6.1. Financial Support. One of the major barriers identifiedby students was financial with many reporting that it wasnecessary to work in order to make ends meet [11, 22–28]. For some, the need to work extended their time in thenursing program [29]. Interestingly, students in the Loftusand Duty study considered the need to work as few as 1–12hours per week to be a significant barrier to their academicsuccess [28]. Working long hours decreased the amount oftime available to study for students [11, 22, 23, 26].

Two common reasons minority students gave for work-ing included the need to cover education expenses as wellas to provide for the living expenses of themselves and theirfamilies [20, 23, 25, 26, 30]. The rising cost of tuition wasconsidered an additional burden and added to minority stu-dents concerns. In an effort to decrease the financial concernsof rising tuition, some of these students chose to enrollin community colleges for prerequisite courses instead ofuniversities. Others identified the lack of financial aid andpressure to begin earning money as reasons for enrolling incommunity college nursing programs instead of universityprograms [26, 29, 30].

Student’s financial challenges were further complicatedby the fact that they had been provided with little or no finan-cial aid information regarding scholarships and grants [25,26]. Most considered loans to be the only available avenue forfinancing their education. Moreover, these students reportedthat their instructors had recommended they work fewerhours or stop working altogether [25, 26].

6.2. Emotional and Moral Support. A lack of emotional andmoral support was perceived to be a key barrier by minoritystudents in most of the studies. This lack of support mani-fested itself in multiple ways including feelings of social iso-lation and loneliness, racism and discrimination, and, finally,through family support issues.

6.2.1. Isolation and Loneliness. Insufficient numbers of Afri-can American students in nursing programs decreased theopportunities for students to connect and develop rela-tionships with other African American students leading tofeelings of social isolation and loneliness [12]. The same wasfound for Hispanic students [26, 29], Native American stu-dents [31], and international students [23]. While initiallyidentifying a lack of other minority students in their pro-grams as “very hard,” some were eventually able to overcomethese feelings as their program grew in size and more mino-rity students were admitted [27].

Hispanic, Native American, African American, Asian,Nigerian, and Eastern Indian students described feelingisolated and lonely both inside and outside the classroom[12, 16, 23–27, 29, 31–33]. These students described beingthe last person chosen as a lab partner and being unable tofind classmates willing to form study groups with them [32].

6.2.2. Discrimination. Multiple studies provided accounts ofstudents being subjected to discrimination and racism byfaculty, preceptors, peers, hospital staff, and patients [12, 16,22, 24, 26, 27, 29, 31, 33, 34]. In one example, a Latinastudent described being told by a male patient that he wanteda White nurse to care for him [22]. Another recounted a pa-tient assuming she must be the nursing assistant and not thenursing student while presuming the blond nursing assistantto be the student nurse. Another student described a patientrefusing to allow a Hispanic nursing student to care for hersaying, “I do not want her to touch me” [27].

The perception that nursing faculty members have a neg-ative bias toward minority students was expressed in many ofthe studies. One student reported, “I was actually confrontedby one of my instructors. . .she took me to her office with noone listening [she told me] that she did not like my face,and she was going to make it extremely difficult for me atschool. And she did” [29]. The perceived discrimination en-countered by Hispanic participants in the same study wasdescribed as “horrific, painful, and frequent.”

African American students described their environmentas “adversarial and nonsupportive” explaining that they wererequired to “excel 10 times more and be more presentable[dress] even on my worst days” [12]. Another student re-counted that she did not believe the White faculty “even knewour names” (page 10). Similarly, others described being mis-understood by classmates and faculty, intimidated, and nega-tively viewed as “lazy” or “dumb” [11, 31].

Students described a “weeding out” process in which fac-ulty members targeted minority students for failure [30].This process was characterized as identifying a student’s aca-demic and clinical weakness and then targeting questionstoward that weakness. One student’s description was, “A stu-dent who had difficulty responding quickly to questionsabout medications they were to give would be grilled evenharder. Each time that student would be in a clinical; theywould be singled out for an intense questioning about theirassignment for the day. This would happen to several stu-dents and by the end of the semester they would be gone”[30].

6.2.3. Family Issues. Issues regarding family support wereidentified as both facilitators and barriers [26]. For somestudents, family members were described as less supportivebecause of gender role stereotyping [11]. Families of His-panic female students did not consider it as important forthem to complete their education as they did for their malefamily members [20].

Female students also struggled with conflicting expecta-tions and the responsibilities of caring for their families andextended families and their studies [16, 24, 26, 29]. Meetingfamily obligations and caring for their children and homeswas found to be of great importance even to the extent ofsacrificing study time [16, 20, 22, 24, 25, 27]. Students whomissed family functions to study or attend class were sub-jected to criticism and negative feedback from family mem-bers [22]. Role stereotyping was identified as a barrier forHispanic males too. Nursing was often considered a female

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Table 1: Presentation of reviewed studies.

Author anddate

Study purpose Study design Sample Findings

Jordan(1996) [34]

Examine livedexperiences of AAstudents in mostlyWhite BSN program

Hermeneuticsstudy—interviews

4 AA nursing students

Three patterns emerged—SeekingIdentity: being only AA student in theclass led to feelings of representing entirerace; Student as Teacher: nursingcurricula did not always include culturaldifferences and was not inclusive;Resoluteness: forced to persevere even inthe face of racism, ignorance, and myths

Villarruelet al. (2001)[29]

Identify barriers andbridges to educationalmobility

Qualitative methodologyutilizing focus groups

37 Hispanic nursesparticipated in focusgroups

Financial considerations requiredparticipants to work while pursuingeducation and reason many choose ADNprogram. Institutional barriers includedunsupportive faculty, perceiveddiscrimination by faculty and peers, lackof advisement, and lack of schedulingflexibility. Cultural/family barriersincluded family care giver or wage earnerresponsibilities

Weaver(2001) [31]

To describe supportsand struggles enduredas student

Survey40 Native Americannurses and nursingstudents

Barriers identified included culture shockor differences, endured stereotypes andracist attitudes, isolation, and assumptionabout cultural identity

Sanner et al.(2002) [23]

Explore theexperiences ofinternational studentsin BSN program.

Guided interview approach8 Nigerian nursingstudents

All students reported becoming sociallyisolated and being prewarned of the socialand academic challenges of the nursingprogram. Further identified the need towork to pay academic and living expenses

Perez (2003)[30]

To buildunderstanding of thenursing educationchoices made byparticipants

Quant./qual. utilizingquestionnaire and interviews

Qualitative—20 MexicanAmericans—all femaleQuantitative—485responses years

Numerous barriers were identifiedincluding financial difficulties and needto be employment, nursing educationconsidered more difficult than expected,stress on family priorities andcommitments

France et al.(2004) [32]

Explore the livedexperiences of AAstudents in a mostlyWhite rural university

Phenomenologicalapproach—interviews

4 AA nursing students

Three themes emerged including—You’rejust shoved in the corner: lack ofrelationships with other students, lack ofcollegiality and lack of support amongclassmates, I have to strive to do the best Ican: students set high expectations forthemselves, and finally, “. . . You just got tomaintain”: students expressedpersevering in spite of obstacles

Gardner(2005a) [16]

Identify the factorsinfluencing success offoreign-born nursingstudents

Case studyEast Indian nursingstudent

Identified barriers included familydemands and obligations, feeling ofexclusion and isolation with regard topeers, and cultural differences including areluctance to speak up in class or makeeye contact with faculty

Gardner(2005b) [24]

To documentminority nursingstudents’ perspectivesof their experiences ina mostly Whiteprogram

Phenomenologicalframework utilizingsemistructured interviews

15 racially and ethnicallydiverse students

Emerging themes included—Lonelinessand Isolation from majority students;Differentness: feeling “different” frommajority students; Absence ofAcknowledgment from faculty; Lack ofUnderstanding from peers about culturaldifferences; Desired Support fromFaculty—but often did not receive it;Coping with Insensitivity andDiscrimination; Determination to buildBetter Future

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Table 1: Continued.

Author anddate


Mills-Wisneski(2005) [33]

To examine AA BSNstudents’ perceptionof impact of absenceof minority faculty

Descriptivedesign-questionnaireutilizing Likert-type scaleand open-ended questioning

71 AA students from 9programs

Students expressed concerns about lackof minority role models and difficultyestablishing relationship with majorityfaculty as well as perception of beingtreated differently by White faculty

Amaro et al.(2006) [22]

To determine diversenursing studentsperceptions ofeducational barriers

Grounded theorymethodology utilizingin-depth interviews

17 ethnically diverserecent graduate RN’s

Student needs and barriers included: lackof time due to family responsibilities, lackof adequate finances, major academicdifficulties—some related to academicbackground and language, and prejudiceand discrimination

Taxis (2006)[11]

To explore theexperiences,perceptions, andfactors that influenceretention andgraduation from amostly White BSNprogram

Qualitative methodologyutilizing questionnaire andface to face interviews, andfocus group

Nine Mexican-Americanstudents in apredominately White BSNprogram or recentgraduates

Identified barriers included financialsituations that required working whichresulted in inadequate time for rest,exercise, and study, not fitting in withAnglo peers, and difficulty functioning intwo separate cultures including theirpredominately White university and theirMexican American peers and family

Goetz (2007)[26]

Identify the barriersfaced by studentscompleting studiesand to identifystrategies used tomanage or overcomebarriers

Qualitative methodologyutilizinginterview—grounded theoryapproach

12 Hispanic nurses andnursing students

Numerous barriers identified including:being ill-prepared for the difficulty andintensity of the nursing program, timemanagement problems balancing home,school and work responsibilities,financial issues, family beliefs andcultural influences, inadequate academicpreparation, and prejudices

Rivera-Gobaand Nieto(2007) [25]

To explore meaningand significance ofmentoring duringprelicensure programfor Latinos in nursing

Phenomenologicalframework utilizingsemistructured interviews

17 Latina students orrecent graduates

Marginalization was identified as a majorchallenge; feeling isolated or as if theylacked knowledge. Financial burdenswere identified as a barrier. Facultysuggested students decrease amount ofwork although students needed to payeducational expenses as well as familyexpenses

Bond et al.(2008) [20]

To identify perceivedbarriers and supportfor retention innursing program

Qualitative—focus groupstudies with theory guideddata analysis

14 Mexican-Americanstudents All Hispanic

Findings included revealed barrierscongruent with model components offinancial issues, emotional and moralsupport issues, professional socializationissues, mentoring, technical support, andacademic advising issues

Coleman(2008) [12]

To explore academicand social experiencesof AA studentsenrolled in a mostlyWhite institution

Qualitative methodologyutilizing semistructuredinterviews

14 African-Americanstudents from a two-yearcommunity college

Four primary themes emerged includingdifference, coping, and survival, supportsystems, and institutional context ashaving significant influence on theexperiences of the students

Evans (2008)[27]

Compare andcontrast perceptionsconcerning barriersbetween minoritystudents and acomparison group ofAnglo students

Descriptive qualitativeutilizing semistructuredinterviews

14 Hispanic andAmerican Indian students

Barriers to success included: financialhardships and work-related issues, heavyfamily obligations, early difficulty relatingto nonminority students and faculty, fearof academic failure, and lack of facultycontact

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Table 1: Continued.

Author anddate


Loftus andDuty (2010)[28]

To determinefacilitators andbarriers to successfulcompletion of a BSNprogram

Naturalistic utilizing survey

314 student participants:White—276Black/AA—16Other minority—17

Five barrier factors were identifiedincluding English language and computerskills, workload and pace of program,financial and family concerns, technologyaccess (owning a computer or havinginternet access), and technologycompetence

Table 1 identifies author(s), study purpose, sample, and brief description of findings for each study.

vocation and not necessarily an appropriate career choice forHispanic males [20, 26].

6.3. Advising and Academic Support. Minority students per-ceived the nursing program to be “much more difficult” thanthey had expected in sharp contrast to the Anglo students inone study [27]. Similarly, others reported having no compre-hension of what would be required of them academically tosucceed in the nursing program [26]. The stereotypical imageof nursing had led them to believe they would learn howto give medications to patients and a few other procedures.Instead, these students were overwhelmed after realizing thiswas only a small portion of what they were required to learn.

Students in the Amaro et al. [22] study believed that theyhad not received adequate support to learn required aca-demic material and reported that they were unaware oftutoring or other support services available to them as nur-sing students. Students in the reviewed studies reported thatthe nursing program workload and pace interfered with theiracademic performance more frequently than nonminoritystudents [26, 28]. The lack of flexibility in scheduling classesand clinical courses was considered an additional barrier forsome students [29].

A lack of knowledge regarding the requirements for ad-mission to nursing programs was identified as an added bar-rier [20, 24, 26, 32]. The lack of appropriate advising duringhigh school and early college years about GPA and pre-requisite course requirements was also acknowledged as pro-blematic. For some, the lack of preparation was due to theschools’ focus on students meeting requirements for gradu-ation rather than preparation for success in college [24].

6.4. Mentoring. Lack of minority faculty to serve as mentorsand role models was identified as challenging for diversestudents. Students reported believing that a mentor wouldhelp them to be more successful in their nursing pro-gram [33]. They identified minority faculty members aseasier to approach. Students described feeling uncomfortableapproaching a nonminority faculty member as well asperceiving a hesitancy on the part of nonminority facultymembers to engage in relationships with them [33]. In addi-tion, these students sought out relationships with minoritynurses they encountered in their clinical experiences. Thesesentiments were echoed in other studies [22, 25].

6.5. Professional Socialization. Ethnic minority student asso-ciations were reported to be very helpful to student membersby providing motivational support and information aboutclasses and strategies to improve academic performance [22].In addition, membership was found to provide social andprofessional support. Unfortunately, such groups are oftenunavailable [22]. When available, many students were notaware of their existence [34]. Regrettably, some studentsreported having too little time for involvement in studentorganizations [20].

6.6. Technical Support. Computer access and technologycompetence were reported in only a single study as significantbarriers to successful academic performance [28]. Studentsreported struggles with accessing a computer for use at homeas well as having access to an internet connection to completeassignments and informational searches. Minority studentsin this study also identified the inability to type and not beingknowledgeable or skillful at using basic software applicationssuch as Microsoft Word as additional barriers.

6.7. Other Themes

6.7.1. Resolve to Succeed. Eight of the reviewed studies des-cribed an additional theme—a resolve to succeed in spite ofthe barriers. While not a concept of the Adapted Model ofInstitutional Support, Bond and colleagues discussed integ-rating such a concept in their 2008 study [20]. Table 2 pro-vides a description of the determination/perseverance themefrom each of the eight studies.

6.7.2. Cultural Competence. Minority students in several ofthe reviewed studies discussed their White peers’ lack ofcultural knowledge and competence as a barrier for them [16,31, 34]. Students expressed feeling exasperated by their class-mates’ limited cultural knowledge, which they attributed toa lack of exposure to diversity [24]. Others attributed it tobeing “uneducated” or “uncomprehending” [34]. Some stu-dents indicated limited cultural content in the program’scurricula as a concern [31].

7. Discussion

While most of these reviewed studies were small, togetherthey begin to paint a picture of the barriers to success many

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Table 2: Resolve to succeed theme.

Author Theme Description

Jordan (1996) [34] ResolutenessResilience in the face of challenge;remaining steadfast to educational goaldespite overwhelming trials

Sanner et al. (2002) [23]Persistence despite perceivedobstacles

Placed the burden on selves to make thenecessary adjustments as they attempted toassimilate

Frances et al. (2004) [32] “. . .you just got to maintain”The participants persevered in spite offeeling isolated and discounted by others

Mills-Wisneski (2005) [33] Persistence and self-motivationAbsence of minority faculty served as acatalyst and motivating factor to succeed innursing program

Gardner (2005b) [24]Determination overcomeobstacles

Success is necessary to build a better future;Desire to overcome despite many obstacles

Amaro et al. (2006) [22]Self-motivation anddetermination

Participants determined to complete theircourses; strength was demonstratingself-motivation and determination

Rivera-Goba andNieto (2007) [25]

PerseveranceIn spite of many roadblocks, perseverancewas the driving force to succeed; had anoverall desire to succeed

Bond et al. (2008) [20] Personal determinationShowed a personal determination to succeedand a desire to give back to other Hispanicstudents still “in the pipeline”

Table 2 provides a description of the Resolve to Succeed/Determination Theme identified in eight of the reviewed studies.

minority nursing students experience during their under-graduate nursing education. These are in addition to thetypical challenges majority nursing students encounter. Thisintegrative review provides an overview of the nursing re-search aimed at identification of those perceived barriers.Results of the review indicate that the successful completionof a nursing education is complicated and there are numer-ous barriers to overcome for minority students.

Financial struggles were common to the student partic-ipants in the reviewed studies. Unfortunately, for nursingstudents who consider financial concerns to be among theirmost difficult barriers, there is not likely to be a great deal ofnew aid available. As a result of the recent economic down-turn and significant deficiencies in most state budgets, statesupport for higher education has been decreasing. Iden-tification and dissemination of information on available stateand federal financial aid through the nursing program willbenefit all students.

Mentoring programs and opportunities for professionalsocialization can become facilitators of success and achieve-ment for diverse students. The transition from student tonursing professional requires planning and active participa-tion both inside and outside the classroom. Minority stu-dents in this review expressed a hesitancy to approach non-minority faculty, suggesting that they could more easily ap-proach minority faculty, but often there are too few minorityfaculty members to serve as mentor and advisor. The devel-opment of formal mentoring and professional socializationprograms will provide safe avenues that students can utilizeto reach out to all available faculty mentors and advisors.

Support for technical and computing competence con-cerns was mentioned in only two of the studies. Computerand technical competence are fundamental skills for nursingstudents and essential for successful program completion. Ina study assessing nursing students’ computer skills, Elder andKoehn [35] found that while students possessed some of theskills necessary in a computerized environment, they lackedmany of the skills required to complete course work includ-ing word processing skills. These students had assessed theirtechnical skills to be very high while their actual assessmentscore showed their skills to be marginal. Elder and Koehnhave recommended that student computer competency beassessed early, permitting accurate course advising aboutthe need to complete a computer course prior to beginningupper level nursing courses.

The findings from this review have implications fornursing faculty and program administrators. Commitmentto the retention and program success of diverse nursingstudents from faculty and administrators can significantlyreduce some of the barriers they face. Data from the reviewedstudies suggests that nursing faculty can have a negativeeffect on minority students’ educational experience throughprejudicial and discriminatory practices. Therefore, faculty’sappreciation of the influential role they have in educatingdiverse nursing students is essential.

A substantial gap, noted in this reviewed body of lite-rature, is that no study included participants who hadbeen unsuccessful or left their nursing program prior tograduation. The literature focused solely on barriers faced bysuccessful students. In fact, several of the studies included

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nurses who had already graduated and successfully com-pleted the NCLEX-RN exam. Minority and ethnic nursingstudents who are not able to persist through to programcompletion may have dissimilar needs or additional barriersto success that were not identified by those students success-fully completing nursing programs. Locating these studentsfor participation in future studies will likely be difficult, butevery effort should be made to include the perspective of thispopulation.

Further study of the Resolve to Succeed/Determination toSucceed theme is warranted. Identification of methods toenhance the determination and resolve of minority studentsto succeed would further aid program directors and facultymembers to design effective strategies to promote success.

8. Conclusions

The number of published articles discussing the need to in-crease diversity in the nursing workforce provides evidencethat this topic is not being ignored. Unfortunately, the under-taking has met with minimal success as yet and in someaspects nursing education has not been responsive to thedilemma of URM nursing students as evidenced by the slowgrowth in numbers of URM nurses. Minority nursing stu-dents face daunting barriers and there is much to be done toimprove the educational process for them. The findings ofthis paper highlight the need to create and maintain nursingprograms capable of actively and aggressively supportingminority student needs as well as facilitating a climate thatis welcoming and caring.

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